In a prior post on this blog, I had referred to Dr. Nemeroff as "Charles Bling Bling Nemeroff," and later apologized for having gratuitously insulted him. I formally rescind that apology.

Why am I getting so exercised about this? Read the articles and you'll understand. But here's a sneak preview.

From the New York Times:

In one telling example, Dr. Nemeroff signed a letter dated July 15, 2004, promising Emory administrators that he would earn less than $10,000 a year from GlaxoSmithKline to comply with federal rules.

But on that day, he was at the Four Seasons Resort in Jackson Hole, Wyo., earning $3,000 of what would become $170,000 in income that year from the British drug giant — 17 times the figure he had agreed on.

And from the Wall Street Journal:

In an Aug. 4, 2004 letter to a university dean, Dr. Nemeroff said he had "taken the necessary steps to be in compliance with the recommendations" of the Emory conflicts-of- interest committee, "namely my consulting fees from GSK will be less than $10,000 per year throughout the period of this NIH grant, its renewals and final collections of data. GSK has been informed of this change and certainly understand the reasons for this decision and is supportive of my compliance with the university recommendations."

But according to Glaxo records, Dr. Nemeroff exceeded the $10,000 limit that month. The payments included a $3,500 fee for a teleconference with the Louisiana State University Psychiatry Department; talks on Paxil at two restaurants in New York —the Passion Fish Restaurant in Woodbury and Burton and Doyles in Great Neck – that paid a total of $7,000; and a $3,500 payment for another teleconference.

In all, according to the Times, Nemeroff "earned more than $2.8 million in consulting arrangements with drug makers between 2000 and 2007, failed to report at least $1.2 million of this income to his university...."

What's the big deal? Nemeroff is the creme de la creme of American psychiatrists. Isn't he entitled to substantial renumeration? Sure. But the problem is, while he was raking in bucket-loads of money from Glaxo, he was also the principal investigator of a 5 year, $3.9 million grant from NIMH to study five Glaxo drugs.

NIMH is part of the National Institutes of Health (NIH), which has a strict conflict of interest policy saying, essentially: "We'll award you this big grant from public money to do important medical research. But in return, we and the taxpayers want to be assured that you are using our money ethically. We don't want you to be making any side deals with companies that might have a vested interest in the results of your NIH research. If you do cut any deals, we insist that you make no more than $10,000 per year, and that you fully disclose these arrangements to your university."

NIH is funny that way. They're really into honesty and integrity.

Dr. Nemeroff broke so many of their rules, so frequently, and so blatantly, that this episode seems more like a fictional allegory to tell your kids at bedtime than the real-life scandal that it is.

Emory promises to investigate. Let's hope they do it quickly, and, if the claims are confirmed, that they promptly relieve Dr. Nemeroff of his duties. His continued chairmanship of Emory's Department of Psychiatry constitutes an embarrassment to the university and to the entire profession of psychiatry.

28 comments:

Hmmm. Brown's "gone to the mattresses," over Keller, as has Harvard, with regard to Beetlejuice. I can't see Emory being any different. Perhaps we should start to question the quality of the education, in these Ivy League institutions (God, how appropriate is that word?), given that their adherence to truth, in other areas, appears to be taxed on a regular basis?

And where are organizations like the APA who should be condemning these behaviors before Grassley can expose more?

Oh, I forgot. One of the shills is the president-elect.

At least I knew Sheldon Preskorn was on the money when he politely wrote back in the late 1990's that Nemeroff was lame. And you really think Emory will do something about this? Like Stanford, Brown, your alma mater Harvard have done so already? Don't hold your breath!

By the way, I applaud your comment about rescinding your apology. Will the lame-o's who tried to call you on your original comments going to come on now and apologize to you?

Here's the amazing thing about this. I won't speak of Dr. Nemeroff specifically, but there are 20 or so VERY well known psychiatrists who over the past ten years have spoken very frequently, in very well known forums, and who are obviously making significant sums of money for this work. Any of us who regularly attend APA or other similar meetings could write the list. The fact that these are researchers has always meant one thing to me: pay NO attention to the result of their research. I've never considered any of them to be good researchers, knowledgable psychiatrists, or expert clinicians. I've considered them as I would consider a paid public relations manager for a given product.

Thought leader? Nothing could be further from the truth for these individuals. The thought leaders are the practicing clinicians.

But here's the part that really bothers me: Why does it take a decade or more for a university to notice something which was obvious to everyone else all along? I suppose they didn't want to throw out the researcher responsible for bringing in so many research dollars. Money talks. And that's what this is all about.

If Nemeroff is guilty as charged, his actions strike at the very basis of treatment and science. Nobody expects they will have to do a background check on their doctor, but unscrupulous physicians are in an unparalleled position to exploit their patients. The basis of federally funded research is the idea that money can be given to dedicated scientists in order to enable them to make advances on behalf of all of us. If we have to spend a considerable fraction of our science budget hiring accountants, we'd have a lot fewer discoveries. Nemeroff should be thoroughly investigated and, if guilty, the penalties should be severe. The actions he's accused of harm all of us.

They are meaningless intimidation of the doctor by paid off goons doing the dirty work of insurance companies. The latter are paying Grassley to attack anyone encouraging the use of brand name medication. The insurance companies want to grow their $trillion reserves. These were grown by defunding hospitals and laying off millions of health workers, totally degrading staffing and quality of care.

You are an unwitting Trojan Horse for heinous, cold-hearted insurance companies.

In Nemeroff's place, I would try to pierce Grassley's Senatorial immunity, suing him for his hate filled intentional interference with my contracts and grants, to deter this vile enemy of clinical care, this agent of insurance company oppressors.

Regarding "[Nemeroff's] continued chairmanship of Emory's Department of Psychiatry constitutes an embarrassment to the university and to the entire profession of psychiatry," the NY Times reported that "On Friday night, Emory announced that Dr. Nemeroff would 'voluntarily step down as chairman of the department, effective immediately, pending resolution of these issues.'"

This deflowering of our academic leaders reminds me of the Catholic priest sex abuse revelations. The priest's transgressions were, of course, a betrayal of parishioners. More profoundly, though, they were a refutation of the concept that practicing the religion will result in the practitioner living a worthy life.

In this case the betrayal is similar, but the profound implication that the scientific method itself is tainted is not the logical consequence that it was in the religious case. Nonetheless, the taint will be generalized by most.

The consequence is sobering. For clinicians, we are left with the irresistible charm of our anecdotal observations (soon we'll be radiating thymus glands again). For the cause of helping society step further toward Enlightenment, a step backward has been taken.

As a Emory med school graduate, one that seriously considered psychiatry, he was a hero and a giant in the department. He actually brought his British bulldog to give a lecture and let it run around the lecture hall, where it got petted by pretty much the entire class.

But that memory is forever tainted by the reality--you cannot be an educator and be responsible for teaching if..if there is any question about being impartial. Its a terrible violation of ethical principles and trust at best, at worst criminal. Is the real appeal of high profile university jobs is the cash cow that follows?

This is going to shake the foundations of "academic psychiatry." We all know this term is an oxymoron. It's kind of like Wall Street. The corrupt heads (and deparmtents) need to fall. And Nemiroff, Keller, Schatzman, and Biederman are just the tip of the iceberg of corruption. And there will be no Congressional bail-out. I am in academic psychiatry and I am sick to my stomach. We have no credibility left even though most of us are well-meaning physcians.

“In occasional cases a physician has encouraged a pharmaceutical house to pander to his need for recognition and allowed himself to be exploited.”

“The negative criticisms [about the relationship between psychiatry and the pharmaceutical industry] which I have had to offer are few compared with the multiple benefits, but I believe action must be taken promptly and effectively in order to maintain that which is begun to promisingly.”

Dr. Kline’s article presaged all except one of the unfavorable aspects of the relationship between psychiatry and the pharmaceutical industry. The exception is seeding trials, which might have not yet arrived to psychiatry in 1957.

From a patient stand point, I'm really concerned. It makes me wonder if I received drugs based upon research done by unethical researchers. What do I trust?

I do feel for those researchers who are ethical, because it does taint the whole field. How are patients supposed to sort out who is ethical & who isn't? How do we know what to believe? How do we trust that the drugs we receive are based upon research that was conducted in an ethical manner?

Stuart Gitlow MD: ... but there are 20 or so VERY well known psychiatrists who over the past ten years have spoken very frequently, in very well known forums, and who are obviously making significant sums of money for this work. Any of us who regularly attend APA or other similar meetings could write the list.

I expect many of these super-shills will have conflict of interest situations similar to Nemeroff's, especially if they operate NIH/NIMH grants. So why not write that list of names down, along with whatever details of suspected shenanigans you can garner and send it to ... Senator Charles Grassley?

I'm shocked SHOCKED! that a researcher is on the take. Come on. Medical research has let itself be turned into a joke by industry. The failure of a few researchers to report is pathetically trivial - almost incomprehensible - in light of the vast sums of money floating around completely in the open: the *reported* grants, honoraria, consultation fees, university donations, the sponsorship of CME and conferences, the direct marketing and advertisements - and - for God's sake - the fact that almost all the prestigious medical societies and journals are industry-sponsored.

It's so open and brazen I can't understand why anyone would bother to hide it and make themselves a poster child for such a rampant and systemic problem. Which, by the way, has been going on in all areas of medicine. But psychiatry, cardiovascular medicine, endocrinology, bariatric medicine and nutrition are particularly infested because the potential worldwide markets here are enormous and so the sums of money being poured in by industry are equally absurd.

I am a professor of psychiatry at Emory and I posted a link to my comment on this situation before athttp://www.beforeyoutakethatpill.com/blog.htmlNot sure if you got it.Talks given by "key opinion leaders" are rife throughout American medicine and it is clear that pharma uses that as a way to generate market share. People like Dr Carlat and others should demand that ALL disciplines should be audited for their outside consulting. Why are we giving cardiologists a free ride? Why is Grassley ONLY looking at psychiatrists? Where is the moral outrage about that? I can tell you why. Because public perception of them is only a fraction above that at the bottom: chiropractors.

Ze Corioca's comment on this blog dated Oct. 5 is inaccurate. The writer said Dr. Alan Schatzberg has campaigned at APA DSM-V committee meetings for criteria favorable to his company. This is not true. The chair and vice-chair of the DSM-V Task Force confirmed that Dr. Schatzberg has had no interaction with the DSM-V Task Force or Work Groups on any issue involving the content of DSM-V. Specifically, he has not advocated for any criteria related to criteria for major depression with psychotic features.

"They are meaningless intimidation of the doctor by paid off goons doing the dirty work of insurance companies. The latter are paying Grassley to attack anyone encouraging the use of brand name medication. The insurance companies want to grow their $trillion reserves. You are an unwitting Trojan Horse for heinous, cold-hearted insurance companies."